Workplace Violence, Workforce Stability, and Well-being in China's Psychiatric Hospitals

Exploring barriers and facilitators in nurses' reporting of patient and visitor violence: a cross-sectional study in China

OBJECTIVES

The current status of patient and visitor violence (PVV) reporting among nurses has proven insufficient. Therefore, we explored the barriers and facilitators in nurses' reporting of PVV.

DESIGN

Cross-sectional study.

SETTING

General and specialised hospitals in Jiangsu Province, China.

PARTICIPANTS

A convenience sampling of 3363 nurses in Jiangsu Province was collected between January and July 2023.

MAIN OUTCOME MEASURE

The reporting rate of PVV was assessed by the hospital workplace violence questionnaire-revised version; multivariable logistic regression analyses were performed to determine factors associated with PVV reporting at the 5% significance level.

RESULTS

Out of the 3363 surveyed nurses, 1813 (53.9%) reported experiencing PVV within the past year. Notably, only 16.1% of these nurses proactively reported PVV incidents after encountering them. Factors that facilitated reporting of PVV comprised being male (OR 1.832, 95% CI 1.083 to 3.101), working in specialised hospitals (OR 2.335, 95% CI 1.517 to 3.594), serving in emergency (OR 1.788, 95% CI 1.105 to 2.892), outpatient (OR 3.153, 95% CI 1.697 to 5.860), paediatrics (OR 3.808, 95% CI 1.976 to 7.338), possessing agreeableness personality (OR 2.112, 95% CI 1.140 to 3.911), prior hearing of PVV (OR 1.749, 95% CI 1.305 to 2.346) and having hospitals that actively encouraged reporting (OR 2.700, 95% CI 1.848 to 3.946) while safeguarding staff interests (OR 2.072, 95% CI 1.010 to 4.248) and emphasising nurses more (OR 2.109, 95% CI 1.123 to 3.958). Conversely, factors impeding nurses from reporting PVV included having night shifts 5-9 times per month (OR 0.481, 95% CI 0.282 to 0.819) and selectively reporting based on the severity of the violence (OR 0.550, 95% CI 0.344 to 0.878).

CONCLUSION

The reporting rate of PVV among nurses was notably low. Nursing managers should consider implementing comprehensive measures that address both the facilitating and blocking factors identified in the study. This strategic approach aims to enhance the reporting rate of PVV incidents among nurses, fostering a safer and more supportive environment within healthcare settings.

The association between the adverse event reporting system and burnout and job satisfaction of nurses: Workplace violence as a mediator

AIMS

This study aims to explore the association between the implementation of the adverse event reporting system (AERS), burnout, and job satisfaction among psychiatric nurses, with a focus on examining the mediating effect of workplace violence from patients.

BACKGROUND

Many organizational and personal factors contribute to burnout and job satisfaction experienced by nurses. AERS, serving as a key component of organizational-level quality improvement system, impacts the overall workplace wellness of nurses.

METHODS

A national sample of 9,744 psychiatric nurses from 41 psychiatric hospitals across 29 provinces in China participated. Burnout was measured by the Maslach Burnout Inventory. Job satisfaction was measured using the Minnesota Satisfaction Questionnaire. Workplace violence was assessed by nurses' experience of verbal and physical violence. Multilevel linear regression analyses were carried out to examine if AERS impacts burnout and job satisfaction and to identify the mediating role of workplace violence.

RESULTS

AERS was positively associated with job satisfaction, but negatively with burnout and workplace violence. Workplace violence exhibited a positive association with burnout and a negative association with job satisfaction. Mediation analyses indicated that the associations between AERS, burnout, and job satisfaction were mediated by workplace violence.

CONCLUSIONS

The application of AERS is associated with a reduction in workplace violence in hospitals, which contributes to the diminished burnout and heightened job satisfaction among psychiatric nurses.

IMPLICATIONS FOR NURSING PRACTICE AND HEALTH POLICY

The study highlights the importance of organizational efforts and mechanisms in promoting nurses' well-being. It is necessary for hospital management to create a safe workplace through the implementation of AERS.

Assessing the mediation pathways: How decent work affects turnover intention through job satisfaction and burnout in nursing

AIM

This study aimed to assess the potential mediating roles of nurses' job satisfaction and burnout in the association between decent work and turnover intention.

BACKGROUND

There is a global challenge of nursing shortages in healthcare systems worldwide. Decent work is crucial for safeguarding the rights and professional development outcomes of nurses. However, there is currently limited research on decent work among nurses, and there is a lack of studies exploring the relationships between nurses' decent work, job satisfaction, burnout, and turnover intention.

METHODS

A cross-sectional survey design was employed with a sample of 460 nurses from three hospitals: The Affiliated Hospital of Hangzhou Normal University, Hangzhou Third People's Hospital, and Hangzhou Red Cross Hospital. The STROBE checklist was used. Mediation analysis using the PROCESS Macro was used to examine the relationships between decent work, job satisfaction, burnout, and turnover intention.

RESULTS

The results showed that nurses' perception of decent work directly influences their turnover intention. Additionally, these findings strongly support the role of job satisfaction and burnout as mediating factors in the relationship between decent work and turnover intention.

CONCLUSIONS

Decent work reduces nurse burnout and turnover intention of enhancing their job satisfaction.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

This study's findings have important implications for healthcare organizations and policymakers. Recognizing the pivotal role of decent work in nurses' job satisfaction and well-being can guide the development of strategies to improve working conditions and reduce turnover rates. It is imperative for healthcare institutions to prioritize creating safe, supportive, and equitable work conditions for nurses, as this can contribute to higher job satisfaction and, subsequently, lower turnover rates.

Association Between Workplace Violence and Post-Traumatic Stress Disorder Among Healthcare Workers in China, 2020 to 2023

This is the first study in China to investigate the prevalence of workplace violence (WPV) and its long-term association with post-traumatic stress disorder (PTSD) among healthcare workers. Conducted across various time points from March 27, 2020, to April 10, 2023, the research employed a four-wave repeated cross-sectional design involving 14,993 healthcare workers from 32 provincial administrative regions across the country. Nurses accounted for 34.3% of the sample, while doctors accounted for 65.7% of the sample, with a higher concentration in western China. Multivariate logistic regression analysis was employed to identify the risk factors for WPV, and hierarchical logistic regression models were used to examine the association between PTSD and WPV. The findings revealed that 71.4% of healthcare workers reported experiencing or witnessing WPV, with nearly half (47.5%) indicating exposure to violent incidents within the past year. Further analysis revealed significant associations between WPV incidence and various factors, including age, gender, work experience, work setting, and a history of contact with Coronavirus Disease 2019 (COVID-19) patients (the odds ratio [OR] of these influencing factors ranged from 1.10 to 2.03. All the p-values were less than .05). 28.5% of healthcare workers displayed symptoms of PTSD, with WPV identified as a major risk factor contributing to these symptoms (lifetime WPV: OR = 1.61, 95% CI [1.47-1.76]; 1-year WPV: OR = 1.75 [1.61-1.90]). Therefore, it is imperative to prioritize the mental health of healthcare workers and implement effective measures to prevent and mitigate WPV, ensuring their physical and psychological well-being as well as occupational safety.

The mediating role of surface and deep acting and the moderating effect of occupational identity in workplace violence and sleep quality among psychiatric nurses: a cross-sectional study

BACKGROUND

Psychiatric nurses often encounter patients with mental health disorders and consequently experience prolonged periods of high stress, increased workload, and frequent incidents of workplace violence. These aspects can lead to a higher incidence of poor sleep quality. This study examined the interplay between workplace violence and emotional labour (surface and deep acting) to suggest measures for enhancing sleep quality among psychiatric nurses.

METHODS

A total of 300 completed and valid online questionnaires were collected. The Pittsburgh Sleep Quality Index was used to measure sleep quality, Workplace Violence Scale (WVS) to measure the occurrence of workplace violence, and Emotional Labour Scale to measure surface and deep acting. The data were analysed using Hayes' PROCESS macro with SPSS. Independent samples t-tests and one-way ANOVA were used to compare differences in sleep quality and emotional labour (surface and deep acting) between psychiatric nurses with different demographics.

RESULTS

The prevalence of poor sleep quality (PSQI > 5) was 55% among the nurses. Surface acting in emotional labour partially mediated the relationship between workplace violence and sleep quality(a1*b1=0.035,95%CI: 0.002, 0.079), whereas deep acting had a suppressive effect(a2*b2=-0.033,95%CI: -0.071, -0.003). Occupational identity had a positive moderating effect on the relationship between workplace violence and surface acting(Effect=0.091,95%CI: 0.004, 0.179).

CONCLUSIONS

The relationship between workplace violence and poor sleep quality was partially mediated by surface acting and suppressed by deep acting. Moreover, nurses with higher occupational identity engaged in more surface acting after workplace violence. Workplace violence, surface acting, and deep acting emerged as significant factors influencing sleep quality among psychiatric nurses. Deep acting can reduce the impact of workplace violence on sleep quality. The results provide a new and expanded view of the interplay between workplace violence and emotional labour concerning sleep quality. Interprofessional collaboration with clinicians, administrators, educators, and spiritual leaders can contribute to the development of related education and training.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2200062347. https://www.chictr.org.cn/showproj.html?proj=173264.

Workplace violence and turnover intention among Chinese nurses: the mediating role of compassion fatigue and the moderating role of psychological resilience

BACKGROUND

Workplace violence is a global public health issue and a major occupational hazard cross borders and environments. Nurses are the primary victims of workplace violence due to their frontline roles and continuous interactions.

OBJECTIVE

The present study aimed to investigate the status of workplace violence, turnover intention, compassion fatigue, and psychological resilience among Chinese nurses, and explore the mediating role of compassion fatigue and the moderating role of psychological resilience on relationship between workplace violence and turnover intention among Chinese nurses.

METHOD

A cross-sectional study was conducted among a convenience sample of clinical registered nurses from public hospitals in Changsha, Hunan, China. Data was collected through an online questionnaire, which included a demographic information form, the Workplace Violence Scale (WVS), the Turnover Intention Questionnaire (TIQ), the Compassion Fatigue Scale (CF-CN), and the Connor-Davidson Resilience Scale (CD-RISC). Descriptive statistics and correlation analysis were employed to examine the relationships among the main variables. A moderated mediation analysis was further conducted using the PROCESS macro for SPSS (Model 4 and Model 8) to examine the mediating role of compassion fatigue and the moderating role of psychological resilience.

RESULT

The present survey recruited a convenience sample of 1,141 clinical registered nurses, who reported experiencing multiple types of workplace violence during the past year. Correlation analysis revealed significant positive correlations between workplace violence and turnover intention (r = 0.466, P < 0.01) as well as compassion fatigue (r = 0.452, P < 0.01), while negative correlation between workplace violence and psychological resilience (r=-0.414, P < 0.01). Moderated mediation analysis revealed that compassion fatigue mediated, while psychological resilience moderated, the positive relationship between workplace violence and turnover intention (all P < 0.05).

CONCLUSION

This study underscores the mediating effect of compassion fatigue and the moderating role of psychological resilience in the relationship between workplace violence and turnover intention among Chinese nurses. Future efforts should be undertaken to develop effective preventive measures and intervention strategies at individual, organizational, and national levels to mitigate workplace violence and foster supportive work environment.

CLINICAL TRIAL NUMBER

Not applicable.

Assessing workplace well-being in healthcare: The violence-prevention climate and its relationship with workplace happiness

AIM

To identify the relationship between the violence-prevention climate and workplace happiness in hospitals. The secondary objective is to adapt a valid and reliable scale to a different culture in healthcare settings.

BACKGROUND

Healthcare settings are not immune to the harmful effects of violence, which can exacerbate existing challenges such as staff shortages. In the midst of these challenges, organizational efforts to ensure the safety of health workers are critical. These efforts can contribute positively to workers' happiness or well-being.

METHOD

Using a cross-sectional design with 400 healthcare professionals from five hospitals in Trabzon, Turkey, data collection involved the Violence-Prevention Climate Scale and Workplace Happiness Scale. Confirmatory factor analysis was conducted to test the Turkish validity and reliability of the scale, and the consistency coefficient was calculated.

RESULTS

The findings revealed that, on average, employees exhibited high levels of violence-prevention climate (x ¯ ${{\bar{\rm x}}}$  = 4.22) and moderate levels of workplace happiness (x ¯ ${{\bar{\rm x}}}$  = 3.70). Subsequently, correlation analysis unveiled a statistically significant association between the dimensions of violence-prevention climate and workplace happiness (p < 0.05, r = 0.392). It was observed that those who experienced violence and did not feel safe in the workplace had lower levels of happiness.

DISCUSSION

The instances of healthcare workers being exposed to violence identified in the study largely align with previous theories related to both individual and organizational effects.

CONCLUSION

Violence-prevention climate affects the safety and workplace happiness of workers.

IMPLICATIONS FOR NURSING AND/OR HEALTH POLICY

Employees expect their managers to seriously consider all reports of violence. In this context, creating a violence-prevention climate would be a good start. According to WHO 2030 targets, in an environment where there is a significant shortage of healthcare personnel, especially nurses, ensuring that existing employees work in a safer and happier environment will make a positive contribution to healthcare systems.

Guided self-help mindfulness-based intervention for increasing psychological resilience and reducing job burnout in psychiatric nurses: A randomized controlled trial

AIMS

The present study aimed to explore the effects of a guided self-help mindfulness intervention on psychological resilience and job burnout among psychiatric nurses.

BACKGROUND

Psychiatric nurses work in challenging and potentially high stress settings. Mindfulness interventions can improve psychological resilience and reduce job burnout of nurses. However, face-to-face delivery of mindfulness interventions may be inconvenient for individuals. Guided self-help interventions may be more accessible.

METHODS

This randomized controlled trial was conducted from January to August 2022. One hundred and eighteen psychiatric nurses were randomized into the intervention and control groups. The individuals in the intervention group received an 8-week guided self-help mindfulness intervention, while the individuals in the control group received a psycho-educational brochure. The Five Facet Mindfulness Questionnaire, the Connor-Davidson Resilience Scale and the Maslach Burnout Inventory-Human Services Survey were used to evaluate the levels of mindfulness, psychological resilience and job burnout, respectively.

RESULTS

After an 8-week intervention, compared with the control group, the levels of mindfulness and psychological resilience were higher, while the level of job burnout was lower in the intervention group.

CONCLUSIONS

The guided self-help mindfulness intervention can improve psychological resilience and reduce job burnout among psychiatric nurses.

A gender-based review of workplace violence amongst the global health workforce-A scoping review of the literature

Workplace violence (WPV) impacts all levels of the health workforce, including the individual provider, organization, and society. While there is a substantial body of literature on various aspects of WPV against the health workforce, gender-based WPV (GB-WPV) has received less attention. Violence in both the workplace and broader society is rooted in gendered socio-economic, cultural, and institutional factors. Developing a robust understanding of GB-WPV is crucial to explore the differing experiences, responses, and outcomes of GB-WPV with respect to gender. We conducted a scoping review and report on the prevalence and risk factors of GB-WPV in healthcare settings globally. The review followed the Preferred Reporting Items for Systematic and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). We registered the scoping review protocol on the Open Science Framework on January 14, 2022, at https://osf.io/t4pfb/. A systematic search was conducted of empirical literature in five health and social science databases. Of 13667, 226 studies were included in the analysis. Across the studies, more women than men experienced non-physical violence, including verbal abuse, sexual harassment, and bullying. Men experienced more physical violence compared to women. Younger age, less experience, shifting duties, specific clinical settings, lower professional status, organizational hierarchy, and minority status were found to be sensitive to gender, reflecting women's structural disadvantages in the workplace. Given the high prevalence and impact of GB-WPV on women, we provided recommendations to address systemic issues in clinical practice, academia, policy, and research.

Sexual Harassment Among Chinese Psychiatrists and Its Impact on Quality of Life: A Cross-Sectional Survey

Objectives

Sexual harassment (SH) is a prevalent issue in various professional fields worldwide. The current study aims to investigate the incidence of SH targeting psychiatrists in China and explore its impact on quality of life (QOL).

Methods

A consecutive recruitment of 1093 psychiatrists was conducted from 6 hospitals in China. The recorded data included participants' socio-demographic characteristics, experiences of workplace SH within the previous year, and their QOL. SH comprised verbal harassment, physical harassment, and displaying of sexual organs. The Chinese version of the World Health Organization Quality of Life Brief Version (WHOQOL-BREF) was employed to assess QOL. We compared the demographic characteristics and QOL between the SH group and the non-SH group. Multiple logistic regression analysis was used to identify independent demographic correlates of SH.

Results

In total, 13.8% (n = 151) of the psychiatrists reported SH, with 5.8% reporting it once, 4.4% reporting it twice, and 3.6% reporting it three times or more. Psychiatrists who had encountered SH exhibited lower QOL across social, psychological, physical, and environmental domains. Multiple logistic regression analysis revealed that young physicians and those with shorter work experience had a higher likelihood of experiencing SH.

Conclusion

The high prevalence of SH among Chinese psychiatrists is of concern. Given its detrimental effects on the well-being of physicians and the quality of medical care they provide, it is crucial to develop specialized employee training programs for this population to effectively manage workplace SH.

Associations among the workplace violence, burnout, depressive symptoms, suicidality, and turnover intention in training physicians: a network analysis of nationwide survey

Depression and anxiety are the most common mental disorders among physicians, who have a greater risk of suicide than those in other professional occupations. Relationships among a demanding workload, workplace violence, burnout, and intention to turnover have also been reported. The current study examined the principal components and propagating patterns of mental health and working environment interactions in training physicians. A total of 1981 training physicians completed online self-report questionnaires during September-October (midpoint of the training year) 2020. Regularized partial correlations in a mixed graphical model (MGM) and joint probability distributions (directed acyclic graph; DAG) were estimated for four subtypes of workplace violence (verbal abuse/physical violence perpetrated by clients/hospital staff), three burnout subdomains (Maslach Burnout Inventory), thoughts about quitting, and nine depressive symptoms, including suicidality, comprising the DSM-5 diagnostic criteria for major depressive disorder (assessed using the Patient Health Questionnaire-9). Thoughts of death/self-harm showed directional dependencies on the joint probability distributions of psychomotor agitation/retardation, concentration difficulty, self-reproach, and sadness in the DAG. In the MGM, a partial correlation with psychomotor agitation/retardation (r = 0.196) accounted for 56.5% of the variance in thoughts of death/self-harm. Partial correlations with concentration difficulties (r = 0.294), self-reproach (r = 0.257), changes in appetite (r = 0.184), and worker-on-worker physical violence (r = 0.240) in the MGM accounted for 54.4% of the variance in psychomotor agitation/retardation. Thoughts about quitting were partially correlated with and dependent upon the joint probability distributions of emotional exhaustion (r = 0.222), fatigue (r = 0.142), anhedonia (r = 0.178), and sadness (r = 0.237). In contrast, worker-on-worker (r = 0.417) and client-on-physician (r = 0.167) verbal abuse had regularized partial correlations with directional dependencies on thoughts about quitting. Organization-level interventions aiming to reduce the worker-on-worker violence and individual-level approaches of clinical screening program and psychiatric counseling clinic are required. Follow-up studies to verify the effectiveness of these interventions for training physicians are needed.

Workplace violence against COVID-19 front-line healthcare workers versus non-front-line in Hangzhou, China: a cross-sectional study

OBJECTIVES

Workplace violence (WPV) against healthcare workers (HCWs) is a global issue. Our research aimed to elucidate the status and associated factors of WPV among front-line/non-front-line HCWs during the COVID-19 pandemic.

DESIGN

This cross-sectional study was conducted among HCWs in Hangzhou City through multistage sampling from December 2020 to January 2021.

PARTICIPANTS

This study included 14 909 valid samples (N=3748 front-line HCWs and N=11 161 non-front-line HCWs).

PRIMARY AND SECONDARY OUTCOME MEASURES

We assessed the WPV status by Chinese version of WPV questionnaire. Binary logistic regression model was established to examine the associated factors of front-line/non-front-line HCWs experiencing WPV.

RESULTS

The total WPV prevalence equalled 37.25% for front-line HCWs and 27.73% for non-front-line HCWs. Among front-line HCWs, females were less likely to experience WPV (OR 0.837, 95% CI 0.710 to 0.988), while individuals who were undergraduate (OR 1.251, 95% CI 1.061 to 1.541) and had higher professional title (intermediate: OR 1.475, 95% CI 1.227 to 1.772; advanced: OR 1.693, 95% CI 1.294 to 2.216) were more likely to suffer from WPV; for non-front-line HCWs, individuals who aged over 50 years old (OR 0.721, 95% CI 0.563 to 0.969), had worked between 10 and 19 years (OR 0.847, 95% CI 0.749 to 0.958) and worked in the non-graded hospital (OR 0.714, 95% CI 0.614 to 0.832) had less chance to experience WPV, while individuals who had higher educational level (undergraduate: OR 1.323, 95% CI 1.179 to 1.484; ≥graduate: OR 1.519, 95% CI 1.217 to 1.895), were nurse (OR 1.142, 95% CI 1.031 to 1.265), and had higher professional title (intermediate: OR 1.458, 95% CI 1.297 to 638; advanced: OR 1.928, 95% CI 1.607 to 2.313) were more inclined to suffer from WPV (p all<0.05).

CONCLUSIONS

This study indicates that the prevalence of WPV among front-line HCWs is significantly higher than among non-front-line HCWs. Policy-makers should prioritise COVID-19 front-line HCWs, especially those with high educational levels and professional titles.

Impact of workplace violence against psychological health among nurse staff from Yunnan-Myanmar Chinese border region: propensity score matching analysis

BACKGROUND

Owing to different social background factor in Yunnan-Myanmar Chinese border region, stressful working environment may lead to extra psychological burden among nurse staff in China. However, the prevalence of workplace violence and its effect on psychological characteristics among nurse staff are still unclear. This study aims to explore the effect of workplace violence against psychological health among nurse staff from Yunnan-Myanmar Chinese border region.

METHODS

A cross-sectional survey was conducted among 18 local governmental hospitals in Dehong districts. Participants were 1,774 nurses. Psychosocial characteristics were screened by sleep quality, the 9-item Patient Health Questionnaire for depressive symptoms, the generalized anxiety disorder-7 for anxiety symptoms, the Connor Davidson Resilience Scale - 10 item for resilience, the multidimensional scale of perceived social support for social support, the Chinese version of Work place Violence Scale for workplace violence. Propensity score matching and multivariate linear regression were applied to analyze the data.

RESULTS

The nurse staff with workplace violence have a higher risk of bad sleep quality (b = -0.883, 95%CI = [-1.171, -0.595]), anxiety symptoms (b = 2.531, 95%CI = [2.031, 3.031]) and depressive symptoms (b = 3.227, 95%CI = [2.635, 3.819]), loneliness (b = 0.683, 95%CI = [0.503, 0.863]), perceived cognitive deficits (b = 1.629, 95%CI = [1.131, 2.127]), poor resilience (b = -2.012, 95%CI = [-2.963, -1.061]), and poor social support (b = -5.659, 95%CI = [-7.307, -4.011]).

CONCLUSIONS

Preventing workplace violence can improve mental health outcomes significantly among nurse staff, including loneliness, perceived cognitive deficits, anxiety symptoms, depressive symptoms, sleep quality, resilience and social support.

Mediating effects of psychological capital on the relationship between workplace violence and professional identity among nurses working in Chinese public psychiatric hospitals: a cross-sectional study

OBJECTIVE

To examine the relationship between workplace violence (WPV) and professional identity among Chinese psychiatric nurses and the mediating effects of psychological capital (PsyCap) from this association.

SETTING

Seven public tertiary psychiatric hospitals in Liaoning Province, China.

PARTICIPANTS

A total of 952 psychiatric nurses were recruited for this study. Registered nurses who have been engaged in psychiatric nursing for more than 1 year were eligible as participants in this investigation.

OUTCOME MEASURES

Questionnaires consisting of the Workplace Violence Scale, the Occupational Identity Scale, the Psychological Capital Questionnaire and a demographic data sheet were used to collect participant information. We used hierarchical multiple regression and asymptotic and resampling strategies to examine the mediating role of PsyCap in the relationship between WPV and professional identity.

RESULTS

WPV was negatively associated with professional identity after controlling for demographic factors (β=-0.353; p<0.001). PsyCap mediated the relationship between WPV and professional identity, according to the mediation analysis (a×b=-0.150, bias-corrected and accelerated 95% CI (BCa 95% CI) (-0.185 to -0.115); p<0.001). In addition, two dimensions of PsyCap: hope (a×b=-0.075, BCa 95% CI (-0.104 to -0.049); p<0.001) and resilience (a×b=-0.064, BCa 95% CI (-0.090 to -0.039); p<0.001) mediated the association between WPV and professional identity. For professional identity, hope, resilience and PsyCap mediation accounted for 21.6%, 18.1% and 42.4%, respectively.

CONCLUSIONS

Based on these findings, PsyCap could partially mediate the relationship between WPV and professional identity. Therefore, hospital administrators should implement measures to prevent and reduce WPV and provide nurses with skills training programmes to improve the PsyCap such as hope and resilience.

Mental health status of mental health nurses in China: Results from a national survey

INTRODUCTION

It has been acknowledged in China that actions should be taken immediately to ease the critical shortage of psychiatric nurses. However, with national data lacking, little is known about nurses' mental health status.

AIM

To evaluate psychiatric nurses' mental health status by measuring their burnout, depression, anxiety and stress.

METHODS

All psychiatric nurses in the 41 selected hospitals in China were invited to participate in the survey. The Maslach Burnout Inventory-Human Service Survey and Depression Anxiety Stress Scale were used to assess variables of interest.

RESULTS

38.6% of psychiatric nurses met the criteria for burnout. The rates of depression, anxiety and stress were 26.3%, 36.4% and 12.5%, respectively. It was found that workplace region, educational level, working years, longer working hours and night shifts were associated with risk of burnout and DASS.

CONCLUSIONS

More than a quarter of psychiatric nurses are suffering from burnout, depression or anxiety in China. Policymakers and hospital administrators should design a flexible schedule and restrict working hours for psychiatric nurses to achieve work-life balance.

IMPLICATIONS FOR PRACTICE

The study informs policymakers and administrators on addressing the nursing shortage by identifying nurses immersed in negative emotions and preventing mental health problems.

Turnover Intention and Its Associated Factors Among Psychiatrists in 41 Tertiary Hospitals in China During the COVID-19 Pandemic

Background

Turnover intention, an employee’s intention to voluntarily leave their jobs, affects workforce sustainability. However, scarce data are available about turnover intention and its associated factors among psychiatrists in China, especially during the COVID-19 pandemic. The current research was designed to address this gap.

Methods

An anonymous, nationwide online survey was disseminated to psychiatrists in 41 psychiatric hospitals in China. We collected demographic data, job-related information (duration of employment, history of participation in the frontline work against COVID-19, job satisfaction), and participants’ turnover intention in the next 12 months.

Results

In total, 3,973 psychiatrists completed the survey. The sample was predominantly female (58.8%) and married (79.5%), and nearly three-fourths (73.5%) had children. More than one-third (35.6%) had a master’s or doctoral degree in addition to their medical degree. The overall level of job satisfaction was moderate. The rate of turnover intention was 22.0% and was comparable in males and females (22.9% in males and 21.3% in females, respectively). Psychiatrists who had participated in the frontline work of COVID-19 were more likely to report an intention to leave their current job. Multiple regression analyses suggested that turnover intention was significantly associated with having insomnia, longer working hours, and more working days per week.

Conclusion

During the pandemic period, approximately one-fifth of psychiatrists in China reported turnover intention. Factors associated with turnover intention included high job-related burdens, low job satisfaction, participation in the frontline work against COVID-19, and insomnia. To improve psychiatric workforce sustainability, policymakers and hospital administrators need to be aware of this potential challenge and address the concerns of psychiatrists in China.

Gender Differences for the Prevalence and Risk Factors of Workplace Violence Among Healthcare Professionals in Shandong, China

Background

Workplace violence (WPV) against healthcare professionals (HPs) has been recognized as important occupational health and societal problem in the world. Many studies were also conducted to explore the prevalence, risk factors, and adverse outcomes of WPV against HPs. Although the gender differences in the prevalence and risk factors of WPV against HPs have been implied in many studies, fewer studies were conducted to explore the gender differences for WPV against HPs, especially in China. In this study, we aim to analyze the gender differences in the prevalence and risk factors of WPV against HPs in Shandong, China.

Methods

This study was conducted among HPs with a cross-sectional design. WPV, social-demographic variables, occupational characteristics, physical disease, social support, and depression were evaluated for the participated HPs. The prevalence and risk factors of WPV among male healthcare professionals (MHPs) and female healthcare professionals (FHPs) were analyzed in this study. Student's t-tests, one-way ANOVA, and logistic regressions were performed to test the associated factors of WPV among MHPs and FHPs.

Results

The prevalence of WPV among MHPs and FHPs was 61.4 and 48.8%, respectively. Being silent was the most common method of response to WPV among MHPs (52.3%) and FHPs (59.2%). For MHPs, the associated factors of WPV were master's degree (odds ratio (OR) =2.20, P < 0.05), bachelor's degree (OR = 2.49, P < 0.001), lower income level (OR = 1.81, P < 0.05), manager (OR = 1.81, P < 0.05), and depression (OR = 1.05, P < 0.001). For FHPs, the associated factors of WPV were a master's degree (OR = 1.58, P < 0.05), more working hours per week (OR = 1.02, P < 0.001), and depression (OR = 1.05, P < 0.001).

Conclusion

The prevalence of WPV among MHPs was higher than FHPs, and the associated factors for WPV against HPs were also different among MHPs and FHPs. The findings remind us that some gender-specific interventions are needed to control WPV against HPs.

Workplace Violence and Turnover Intention Among Psychiatrists in a National Sample in China: The Mediating Effects of Mental Health

BACKGROUND

Workplace violence (WPV) in healthcare has received much attention worldwide. However, scarce data are available on its impact on turnover intention among psychiatrists, and the possible mechanisms between WPV and turnover intention have not been explored in China.

METHODS

A cross-sectional survey was conducted among psychiatrists in 41 tertiary psychiatric hospitals from 29 provinces and autonomous regions in China. A stress-strain-outcome (SSO) model was adopted to examine the effects of WPV on mental health and turnover intention. The association and mediation by burnout and stress were examined by multivariate logistic regression (MLR) and generalized structure equation modeling (GSEM).

RESULTS

We invited 6,986 psychiatrists to participate, and 4,520 completed the survey (64.7% response rate). The prevalence of verbal and physical violence against psychiatrist in China was 78.0 and 30.7%, respectively. MLR analysis showed that psychiatrists who experienced verbal violence (OR = 1.15, 95% CI = 1.10-1.21) and physical violence (OR = 1.15, 95% CI = 1.07-1.24) were more likely to report turnover intention. GSEM analysis showed that burnout (β = 4.00, p < 0.001) and stress (β = 1.15, p < 0.001) mediated the association between verbal violence and turnover intention; similarly, burnout (β = 4.92, p < 0.001) and stress (β = 1.80, p < 0.001) also mediated the association between physical violence and turnover intention.

CONCLUSIONS

Experience of WPV is a significant contributor to turnover intention among psychiatrists. Mental health status, such as burnout and stress level significantly mediated the association. Policy makers and hospital administrators need to be aware of this association. Action is needed to promote mental health among the psychiatrists to improve morale and workforce sustainability.